Healthcare Provider Details

I. General information

NPI: 1881521250
Provider Name (Legal Business Name): TYLER ARCHEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E BROADWAY APT 529
LONG BEACH CA
90802-6267
US

IV. Provider business mailing address

250 E BROADWAY APT 529
LONG BEACH CA
90802-6267
US

V. Phone/Fax

Practice location:
  • Phone: 951-392-7139
  • Fax:
Mailing address:
  • Phone: 951-392-7139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number95296783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: